As Escherichia coli enteropatogênica atípicas (EPECa) são capazes de causar a lesão A/E e não transportam o pEAF. Biofilmes microbianos são definidos como comunidades complexas formadas por microrganismos aderidos a superfícies envoltas por uma matriz de exopolissacarídeos. O objetivo deste estudo foi verificar a capacidade de formação de biofilme de 92 amostras de EPEC atípicas em superfícies abióticas e células pré-fixadas, utilizando três metodologias (contagem de UFC/cm2), ensaio colorimétrico com cristal violeta e CLSM). O gene shf e bfpA parecem não ter relação com a formação de biofilme. Não houve diferença significativa de formação de biofilme nas superfícies testadas. Através de CLSM foi possível verificar a formação de biofilme em EPECa. Os biofilmes visualizados em CLSM revelaram uma grande heterogeneidade das amostras. Uma metodologia qualitativa, como CLSM deve ser empregada para indicar a formação de biofilme. A adesão e formação de biofilme por EPEC atípica de longo período pode ser uma possível explicação para os casos de diarréia persistente. / The atypical Escherichia coli enteropathogenic (EPECa) are capable to cause the lesion A/E and they don\'t transport the pEAF. Microbial biofilms are defined as complex communities formed by microrganisms adhered to surfaces embedded in an exopolysacharidic matrix. The objective of this study was to verify the capacity of formation of biofilm of 92 strains of atypical EPEC in abiotics and pre-fixed cells surfaces, using three methodologies (counting of UFC/cm2), colorimetric assay with violet crystal and CLSM). The gene shf and bfpA seem not to have relationship with the biofilm formation. There was not significant difference of biofilm formation in the tested surfaces. Through CLSM it was possible to verify the biofilm formation in EPECa. The biofilms visualized in CLSM revealed a great heterogeneity of the strains. A qualitative methodology, like CLSM should be used to indicate the biofilm formation. The adhesion and biofilm formation for atypical EPEC of long period can be a possible explanation for the cases of persistent diarrhea.

Escherichia coli enteropatogênica (EPEC) é um dos principais agentes de diarréia em crianças nos países em desenvolvimento. Esse patótipo pode ser classificado em dois grupos: EPEC típica (t-EPEC) e EPEC atípica (a-EPEC). O objetivo principal deste estudo foi traçar o perfil plasmidial de 78 amostras de a-EPEC bem como investigar em 72 amostras a presença de genes de virulência descritos em outros patótipos de DEC para procura de um marcador de virulência específico deste grupo de amostras. Foi detectada a presença de alguns genes de virulência como: pet (5,5%), pic (2,7%), astA (18%), efa1/lifA, toxB (2,7%), ldaH (8,3%) e ehly1 (4,2%). Os perfis plasmidiais obtidos permitiram verificar que entre as 78 amostras analisadas, 12 não possuem plasmídio, 33 possuem plasmídios entre 50 a 90 kb e 38 possuem plasmídios entre 90 a 124 kb. A pesquisa dos grupos de incompatibilidade revelou que os grupos IncFIB e IncF são os mais freqüentes entre as amostras de a-EPEC. Os resultados de RFLP do DNA plasmidial das amostras do sorotipo O55:H7 sugeriu que existem seqüências de nucleotídeos comuns entre os plasmídios. Os dados obtidos também permitiram inferir a existência de fragmentos de DNA plasmidial comum entre amostras de EHEC O157:H7 e amostras de a-EPEC O55:H7. A função biológica dos plasmídios de a-EPEC e a relação com o plasmídio pO157 necessitam de estudos complementares. / Escherichia coli (EPEC) is one of the main agents of diarrhea in children in developing countries. This pathotype can be classified in two groups: typical EPEC (t-EPEC) and atypical EPEC (a-EPEC). The aim of this study was to determine the plasmid profile of 78 strains of a-EPEC and investigate 72 strains for the presence of virulence genes described in other DEC. It was detected the presence of some virulence genes: pet (5,5%), pic (2,7%), astA (18%), efa1/lifA, toxB (2,7%), ldaH (8,3%) e ehly1 (4,2%). The plasmid profiles obtained allowed us to verify that among the 78 samples analyzed, 12 did not have plasmids, 33 strains have plasmids ranging between 50 and 90 kb, and 38 have plasmids ranging between 90 to 124 kb. Incompatibility groups analysis revealed that IncFIB and IncF groups are the most frequent among the samples of a-EPEC. RFLP analysis of plasmid DNA of strains of serotype O55:H7 suggested that there are nucleotide sequences common to the plasmids. The data also allowed inferring the existence of fragments of plasmid DNA common to EHEC O157:H7 and a-EPEC O55:H7. The biological function of aEPEC plasmid and the relationship with pO157 requires further studies.

A inclusão de óleos em dietas de leitões recém-desmamados tem por finalidade aumentar a densidade energética para atender às exigências energéticas dos leitões. Foram realizados dois experimentos para avaliar a inclusão do óleo semirrefinado de arroz como substituto ao óleo refinado de soja em dietas de leitões recém-desmamados. O Experimento 1 teve como objetivo determinar os valores de energia digestível e metabolizável dos óleos de arroz e soja para leitões na fase de creche. Foram utilizados 21 leitões, machos castrados, com peso inicial de 19,63 ± 0,37 kg, em um experimento em blocos completos casualizados, com sete repetições e um animal por unidade experimental (gaiola de metabolismo). Foi utilizado o método de coleta total de fezes e urina, sendo que o óleo substituiu 10% da ração-referência. Os valores de energia digestível, energia metabolizável e energia metabolizável corrigida para balanço de nitrogênio foram, respectivamente, 6.267, 6.158 e 6.213 kcal/kg para o óleo semirrefinado de arroz e 7.581, 7.489 e 7.527 kcal/kg para o óleo refinado de soja. Os valores energéticos do óleo de arroz foram em média 17,5% inferiores aos do óleo de soja, possivelmente, pela menor relação de ácidos graxos insaturados:saturados e pelo maior conteúdo de ácidos graxos livres no óleo semirrefinado de arroz. O Experimento 2 teve como objetivo avaliar os efeitos da substituição do óleo refinado de soja (OS) pelo óleo semirrefinado de arroz (OA) em dietas para leitões recém-desmamados sobre o desempenho, a histologia intestinal, a morfometria de órgãos e a ocorrência de diarreia. Foram utilizados 120 leitões desmamados, machos castrados e fêmeas, com peso inicial de 6,74 ± 0,42 kg, em um experimento em blocos completos casualizados, com oito repetições e três animais por unidade experimental (baia). Foram avaliados cinco níveis de substituição OS:OA na dieta: 4:0 dieta basal com 4% de OS; 3:1 dieta basal com 3% de OS e 1% de OA; 2:2 dieta basal com 2% de OS e 2% de OA; 1:3 dieta basal com 1% de OS e 3% de OA; e 0:4 dieta basal com 4% de OA. As dietas isonutritivas foram formuladas considerando os valores de energia metabolizável corrigida para balanço de nitrogênio determinados no Experimento 1. Não houve efeito dos níveis de substituição sobre o desempenho, a morfometria de órgãos e a ocorrência de diarreia. Houve efeito quadrático sobre a largura de vilosidade e efeito cúbico sobre a relação altura de vilosidade:profundidade de cripta no duodeno. Portanto, considerando os valores de energia dos óleos na formulação de dietas isonutritivas para leitões em fase de creche, o óleo semirrefinado de arroz pode substituir totalmente o óleo refinado de soja (4%) sem afetar o desempenho zootécnico, a morfometria de órgãos dos animais, nem a ocorrência de diarreia. / The purpose of the inclusion of oils in weanling pig diets is to increase diet energy density to meet energy requirement of pigs. Two experiments were conducted to evaluate the effects of the inclusion of semi-refined rice oil replacing refined soybean oil in diets of weanling pigs. Experiment 1 was carried out to determine digestible and metabolizable energy values of rice and soybean oils for weanling pigs. Twenty one borrows averaging 19.63 ± 0.37 kg BW were used in a randomized complete block design experiment, with seven replications and one pig per experimental unit (metabolism cage). Total collection method of feces and urine was used, and the oil replaced 10% of reference diet. Values of digestible energy, metabolizable energy and N-corrected metabolizable energy were, respectively, 6,267, 6,158 and 6,213 kcal/kg for semi-refined rice oil and 7,581, 7,489 and 7,527 kcal/kg for refined soybean oil. Energy values of rice oil were around 17.5% lower than values of soybean oil, possibly, due to the smaller unsaturated:saturated fatty acids ratio and due to the higher free fatty acids content in the semi-refined rice oil. Experiment 2 was conducted to evaluate the effects of the replacement of refined soybean oil (SO) by semi-refined rice oil (RO) in weanling pig diet on performance, intestinal histology, organs morphometry and the occurrence of diarrhea. One hundred and twenty weaned pigs, borrows and females, averaging 6.74 ± 0.42 kg BW, were used in a randomized complete block design experiment, with eight replications per treatment and three animals per experimental unit (pen). Five dietary levels of SO:RO replacement were studied: 4:0 basal diet with 4% of SO; 3:1 basal diet with 3% of SO and 1% of RO; 2:2 basal diet with 2% of SO and 2% of RO; 1:3 basal diet with 1% of SO and 3% of RO; and 0:4 basal diet with 4% of RO. Isonutritive diets were formulated considering N-corrected metabolizable energy values determined in Experiment 1. No effects of substitution levels were observed on performance, organs morphometry and occurrence of diarrhea. However, a quadratic effect on villus width and a cubic effect on villus height:crypt depth ratio were observed in the duodenum. Therefore, considering the energy values of oils in the formulation of isonutritive weanling pig diets, semi-refined rice oil can replace the refined soybean oil (4%) without affecting growth performance, organs morphometry of animals, or the occurrence of diarrhea.

O objetivo deste trabalho foi avaliar misturas (blends) de acidificantes e seus sais como alternativas aos antimicrobianos melhoradores do desempenho de leitões na fase de creche. Foi realizado um experimento em blocos casualizados, com 34 dias de duração para testar cinco tratamentos. Para o período de 1 a 14 dias, os tratamentos foram: Am (antimicrobiano) - dieta pré-inicial com 0,004% de sulfato de colistina (40 ppm); A1 (acidificante 1) - pré-inicial com 0,5% do blend 1 (contendo ácido fórmico, 145.000 ppm; ácido fosfórico, 85.000 ppm); A2 (acidificante 2) - pré-inicial com 0,15% do blend 2 (butirato de sódio, 64.000 ppm) e 0,4% do blend 3 (ácido láctico, 620.000 ppm; ácido fórmico, 40.000 ppm); A3 (acidificante 3) - pré-inicial com 0,8% do blend 4 (ácido propiônico, 198.000 ppm; ácido acético, 196.000 ppm; ácido fórmico, 196.000 ppm; ácido fosfórico, 21.000 ppm; ácido cítrico, 8.500 ppm); A4 (acidificante 4) - dieta basal com 0,6% do blend 4 e 0,15% do blend 5 (ácido benzóico, 590.000 ppm; ácido fórmico, 70.000 ppm; ácido fosfórico, 50.000 ppm; ácido cítrico, 40.000 ppm). Para o período de 14 a 34 dias, os tratamentos foram: Am - dieta inicial com 0,004% de sulfato de colistina; A1 - inicial com 0,3% do blend 1; A2 - inicial com 0,1% do blend 2 e 0,3% do blend 3; A3 - inicial com 0,6% do blend 4; A4 - inicial com 0,5% do blend 4 e 0,1% do blend 5. Foram utilizados 160 leitões Topigs recém-desmamados, com idade média em torno de 24 dias e peso inicial de 6,69±1,82 kg. Foram alocados quatro leitões (dois machos castrados e duas fêmeas) em cada baia (unidade experimental). Para os dados de desempenho e freqüência de diarréia, foram utilizadas 8 repetições (blocos) por tratamento. Ao final do experimento, um animal de cada baia, dos 4 primeiros blocos, foi abatido para análise da morfologia intestinal, pH estomacal e cecal e morfometria de órgãos. Durante a fase pré-inicial, o tratamento A2 (combinação dos blends 2 e 3) proporcionou melhor peso aos 14 dias (P14) (P=0,03) e ganho diário de peso (GDP) (P=0,04) que o tratamento A3 (blend 4), e melhor conversão alimentar (CA) (P=0,004) que o tratamento Am (antimicrobiano). Para o período total, o tratamento A4 (blends 4 e 5) apresentou melhor CA (P=0,0006) que o tratamento Am (antimicrobiano). Os tratamentos não afetaram (P>0,05) a freqüência de diarréia e o pH estomacal. O tratamento A4 (blends 4 e 5) apresentou menor valor de pH cecal (P=0,015) que o tratamento Am e menor valor de peso relativo do pâncreas (P=0,013), comparado aos tratamentos Am e A2. Para morfologia intestinal, o tratamento A2 proporcionou menores valores de profundidade de cripta (PC) (P=0,03) do jejuno que os tratamentos A3 e Am e maior relação altura de vilosidade:profundidade de cripta (P=0,04) do jejuno que os tratamentos A1 e A3. A análise econômica, no período de 1 a 14 dias, mostrou que os acidificantes propiciaram custos por kg de GDP, no mínimo, 4,09% inferiores ao antimicrobiano (Am). No período de 1 a 34 dias, os tratamentos A1 e A4 apresentaram custos por kg de GDP até 1,08% menores que o Am. Assim, o presente estudo mostrou que misturas de ácidos orgânicos, inorgânicos e seus sais podem ser uma alternativa viável aos antimicrobianos melhoradores do desempenho de leitões na fase de creche. / The purpose of this work was to evaluate several acidifier blends as alternatives to antimicrobial growth promoters of weanling pigs. A 34-d randomized complete block design experiment was carried out to compare five treatments. For 1-14 d experimental period, the treatments were: Am (antimicrobial) - pre-starter diet with 0.004% of colistin sulfate (40 ppm); A1 (acidifier 1) - pre-starter diet with 0.5% of blend 1 (containing formic acid, 145,000 ppm; phosphoric acid, 85,000 ppm); A2 (acidifier 2) - pre-starter diet with 0.15% of blend 2 (butyric acid, 64,000 ppm) and 0.4% of blend 3 (lactic acid, 620,000 ppm; formic acid, 40,000 ppm); A3 (acidifier 3) - pre-starter diet with 0.8% of blend 4 (propionic acid, 198,000 ppm; acetic acid, 196,000 ppm; formic acid, 196,000 ppm; phosphoric acid, 21,000 ppm; citric acid, 8,500 ppm); and A4 (acidifier 4) - pre-starter diet with 0.6% of blend 4 and 0.15% of blend 5 (benzoic acid, 590,000 ppm; formic acid, 70,000 ppm; phosphoric acid, 50,000 ppm; citric acid, 40,000 ppm). For 14-34 d experimental period, the treatments were: Am - starter diet with 0.004% of colistin sulfate; A1 - starter diet with 0.3% of blend 1; A2 - starter diet with 0.1% of blend 2 and 0.3% of blend 3; A3 - starter diet with 0.6% of blend 4; and A4 - starter diet with 0.5% of blend 4 and 0.1% of blend 5. One hundred and sixty Topigs 24-d-weaned pigs, with 6.69±1.82 kg live weight were allotted to 20 suspended pens, with four pigs (two castrated male and two female) per pen (experimental unit). For performance and diarrhea incidence data, 8 replications per treatment were used. On 34th day of experimental period, an animal of each pen of first 4 blocks was slaughtered for small intestine morphology, stomach and caecum pH and organs morphometry. For 1-14 d experimental period, treatment A2 (combination of blends 2 and 3) gave better body weight at 14th day (BW14) (P=.03) and average daily gain (ADG) (P=.04) than treatment A3 (blend 4), and better feed conversion (FC) (P=.004) than treatment Am (antimicrobial). For total experimental period (1-34 d), treatment A4 (blends 4 and 5) gave better FC (P=.0006) than treatment Am (antimicrobial). Treatments did not affect (P>.05) diarrhea frequency and stomach pH. Treatment A4 (blends 4 and 5) gave lower pH value (P=.015) than treatment Am and smaller relative pancreas weight (P=.013) than treatments Am and A2. For intestinal morphology, treatment A2 provided smaller (P=.003) jejunum crypt depth (CD) than treatments A3 and Am, and bigger (P=.04) ratio of jejunum villus height:crypt depth than treatments A1 and A3. Economical analysis showed, for 1-14 d experimental period, that the acidifiers provided cost per kg of ADG at least 4.09% lower than antimicrobial (Am). For 1-34 d experimental period, treatments A1 and A4 showed cost per kg of ADG until 1.08% lower than Am. Therefore, this study showed that blends of organic and inorganic acids and their salts can be viable alternatives to antimicrobial growth promoters of weanling pigs.

L’épidémiologie des diarrhées aiguës (DA) hivernales a été peu décrite chez l’adulte. Ces DA sont principalement dûes à des virus entériques. Des virus influenza peuvent être détectés l’hiver dans les selles de patients grippés présentant des signes digestifs, mais on ignore s’ils peuvent être retrouvés chez des patients présentant exclusivement des troubles digestifs. Durant les hivers 2010/2011 et 2011/2012, les médecins Sentinelles (Inserm-UPMC) ont inclus 192 patients adultes consultant pour une DA et 105 patients contrôles. Un prélèvement de selles était effectué pour la recherche de norovirus (génogroupes I et II), rotavirus du groupe A, adenovirus entérique humain, astrovirus et virus influenza A(H1N1)pdm2009, A(H3N2) et B. Durant les hivers étudiés, l’incidence moyenne des DA chez l’adulte a été estimée à 3158 pour 100 000 adultes (IC 95% [2321 – 3997]). Un traitement était prescrit pour 95% des patients avec une DA, et un arrêt de travail pour 80% des patients actifs. Les examens de selles ont permis de détecter un virus entérique chez 65% des patients diarrhéiques, le plus souvent un norovirus (49%). Parmi les patients présentant une DA, 7,2% étaient positifs à un virus influenza, ces derniers n’ayant pas rapporté de signes respiratoires. Les symptômes décrits par les patients diarrhéiques adultes ne différaient pas en fonction de la présence ou absence d’un virus entérique. Les patients contrôles ne présentaient ni virus entériques ni virus influenza dans leurs selles. Aucun facteur risque évitable n’a été identifié, autre que le contact avec une personne malade au sein du foyer et/ou en dehors, rapporté chez 46,2% des patients ayant consulté pour une DA. / The epidemiology of winter acute diarrheas (AD) has not been described in adults. These AD are mainly due to enteric viruses. In winter, influenza viruses can also be detected in stools of influenza patients with digestive signs, but we don’t know if these viruses can be found in the stools of patients suffering from digestive disorders exclusively. During the 2010/2011 and 2011/2012 winters, general practitioners (GPs) from the Sentinelles network (Inserm-UPMC) included 192 adult patients consulting for an AD and 105 control patients. Stool samples were collected and tested for norovirus (genogroups I and II), group A rotavirus, human enteric adenovirus, astrovirus and influenza viruses A(H1N1)pdm2009, A(H3N2) and B.During the studied winters, the average incidence of AD in adults was estimated to be 3,158 per 100,000 adults (95% CI [2,321 – 3,997]). GPs prescribed a treatment in 95% of the patients with AD, and 80% of the working patients with AD could not go to work. Stool examinations were positive for at least one enteric virus in 65% of cases, with a predominance of noroviruses (49%). Of the patients suffuring from an AD, 7.2% tested positive for one influenza virus, none reported respiratory symptoms. Among the patients with AD, the reported clinical signs did not differ between adults with a virus in the stool sample and those with no virus found in the stool exam. None of the controls tested positive for one of the enteric and/or other influenza viruses.No preventable risk factor was identified, other than the contact with a sick person within and/or outside the household, reported by the patient in 46.2% of cases.

No description available.

Chlamydiae may exist at the site of infection in an alternative replicative form, called the aberrant body (AB). ABs are produced during a viable but non-infectious developmental state termed "persistence" or "chlamydial stress." As persistent/stressed chlamydiae: (i) may contribute to chronic inflammation observed in diseases like trachoma; and (ii) are more resistant to current anti-chlamydial drugs of choice, it is critical to better understand this developmental stage. We previously demonstrated that porcine epidemic diarrhea virus (PEDV) co-infection induced Chlamydia pecorum persistence/stress in culture. One critical characteristic of persistence/stress is that the chlamydiae remain viable and can reenter the normal developmental cycle when the stressor is removed. Thus, we hypothesized that PEDV-induced persistence would be reversible if viral replication was inhibited. Therefore, we performed time course experiments in which Vero cells were C. pecorum/PEDV infected in the presence of cycloheximide (CHX), which inhibits viral but not chlamydial protein synthesis. CHX-exposure inhibited PEDV replication, but did not inhibit induction of C. pecorum persistence at 24 h post-PEDV infection, as indicated by AB formation and reduced production of infectious EBs. Interestingly, production of infectious EBs resumed when CHX-exposed, co-infected cells were incubated 48-72 h post-PEDV co-infection. These data demonstrate that PEDV co-infection-induced chlamydial persistence/stress is reversible and suggest that this induction (i) does not require viral replication in host cells; and (ii) does not require de novo host or viral protein synthesis. These data also suggest that viral binding and/or entry may be required for this effect. Because the PEDV host cell receptor (CD13 or aminopeptidase N) stimulates cellular signaling pathways in the absence of PEDV infection, we suspect that PEDV co-infection might alter CD13 function and induce the chlamydiae to enter the persistent state.

The incidence and causes of diarrhoea among critically ill patients receiving enteral tube feeding were investigated. Sixty acutely ill surgical or medical intensive care patients who had had a minimum of 48 hrs bowel rest were entered into the study. They were randomly assigned to receive one of two lactose free liquid formula diets - "Ensure", a commercially available feed containing 825 kCal/L and 34 g/L of protein with an osmolality of 441mOsm/1 or "Casilan Oil", a home-made feed containing 840 kCal /L and 45g/L of protein with an osmolality of 383 mOsm/1. The feeds were administered by constant nasogastric infusion. Patients received 1000ml at a rate of 40ml per hour for the first day and up to 2000ml at 80 ml per hour for the remainder of the study period. Investigations included documentation of medical history, medications administered and clinical details for each patient. Serum albumin was measured and the nutritional status of each patient was assessed using anthropometric measurements. Feeds were tested for bacterial contamination on the three days following the start of feeding and small intestinal bacterial overgrowth was assessed by the 1 g-¹⁴C Xylose breath test of Toskes and King. Twelve of the sixty patients had to be withdrawn from the trial within 24 hours of the start of enteral feeding for medical reasons. The remaining forty eight patients completed at least three days on enteral feeding and thereby became eligible for analysis. In 10/48 patients (21%) diarrhoea was present before enteral feeding began. Four of these 1 O patients continued to pass loose stools when enteral feeding was started while the remaining 6 settled. Diarrhoea developed in a further 10 patients (21%) after enteral feeding began. The overall incidence of diarrhoea in the group of critically ill patients studied was therefore 42% (20/48). However, of the fourteen patients who experienced diarrhoea during enteral feeding four had diarrhoea before feeding began. Therefore, the true incidence of diarrhoea related to enteral feeding was only 10/38 (26%). Furthermore, in 7 of these 10 patients, another possible cause of diarrhoea was present. There was no significant association between diarrhoea and nutritional status, hypoalbuminaemia, sepsis, length of bowel rest, sucralfate and antibiotic therapy other than amikacin. Twenty one patients received Ensure and 27 received Casilan Oil. Despite the differences in the composition of the feeds, the incidence of diarrhoea was similar on the Ensure and the Casilan Oil. No particular factor pertaining to the composition of the feeds was associated with diarrhoea. Significant contamination of feeds was universal but there was no constant relationship between bacterial counts, or types, and the occurrence of diarrhoea. Certain other factors were found to be significantly associated with diarrhoea. Abdominal injury was positively associated with the occurrence of diarrhoea (p<0.05). Diarrhoea could have been attributed to the underlying disease state in 7 of the patients. All three patients who were receiving lactulose as treatment for liver failure developed diarrhoea. While no association was noted between diarrhoea and antibiotic therapy in general, treatment with the antibiotic, amikacin, correlated significantly, albeit marginally, with the occurrence of diarrhoea (p<0.05). Twenty six patients were tested for small intestinal bacterial overgrowth. Only one patient, with an elevated excretion of ¹⁴CO₂, indicative of small intestinal bacterial overgrowth, developed diarrhoea. There was, however, a positive association between diarrhoea and decreased excretion of ¹⁴CO₂. It would appear that the bacterial flora was suppressed in patients with diarrhoea. Amikacin therapy was also associated with decreased excretion of ¹⁴CO₂. This may suggest that amikacin could have altered the bowel flora with resultant development of diarrhoea. While abdominal injury and disease were associated with the development of diarrhoea and amikacin was a possible factor associated with diarrhoea, the results of the present study indicate that enteral tube feeding with either the commercial feed, Ensure or the home-made feed, Casilan Oil was not a cause of diarrhoea in the majority of critically ill patients assessed. Furthermore, in most patients who commenced the trial with diarrhoea, improvement was noted on enteral feeding.

During the last two or three years, the three largest hospitals in Stockton (St. Joseph’s, Dameron and San Joaquin General Hospitals) have modified their procedures to include the search for Campylobacter. On the other hand, the incidence of Yersinia in California is unknown, as most clinical laboratories do not specifically culture for it. There have been only a few reports of Yersinia in this state (personal communication of Dennis Ferrero, Director of the San Joaquin County Public Health Laboratory). This study has a threefold purpose: to investigate the incidences of Campylobacter and Yersinia, especially in relation to the incidence of Salmonella and Shigella, to study the biochemical and antibiogram characteristics of enteric isolates, particularly the “newer” pathogens, and to review the state of routine culture methods and assess their adequacy.

No description available.